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PLANNING ANRDEVELOPMENT SERVICES DEP. T
BUILDING.AND CODE REGULATIONS.DIV-ISION", ^'64
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FORT PIERCE.FL 34982 c
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(772)4624553 `Fax(772)46261575
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PERMIT RENEWAL REQUEST
`PERWNIIT N'u1N BER: [ lP b 3 ' ( ro�04 ADDRESS: a'0
am,requesttng that=-be above b '-renewed. j
undeistaild-thatI must.schedule and pass all fequired' nspections for.the perniit,to be finaled `Further,,1
understand that this is a O.NE'TEN4E.RENEWAL aod'the;pennit,shall.expire sho.'uId L t,receive a
pas 'ins pection durni an six fnonth erlod durin the renewalperiod.
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Justification,. W.D_ �,��1. ` t�- w�_
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OWNERBLQR .R CO, TRACTOR-SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY-OE" I%l" :(1
-Y
ACKNOWLEDGED BEFORE:METHIS 1 DAY OF Yt 20. 'Lo
,BY l�rv/ tri WHO IS PERSONALLY KNOWN TO ME 'OR
HAS PROVIDED. AS IDENTIFICATION.
STATE OF FLORIDA,County of
-. ,� l�Osary.PuDlaaSUta:of Ftoiida
Ke
Q� W commission GG 367402
SI, i TUREOF•NOTARY SEAL 0*
FOR OFFICE„U$E ONLY:,
Number of Open Inspections:
Total'Inspections:
(Divide opei by total-to get%of open inspection's)
Percentage:
Original,pernutfee:, x%o,open =;, .$7 :Renewal fee,
i
Example: i'5 divided by'-2-5 ,65(°fo)] $.115(oermitfee)x.65=$113.-75(renewal fee)
Revised'7/21f20.a
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